headache

Question 1

tension

Answer 1

bilateral tight band
assoc w stress
late in day

Question 2

cluster

Answer 2

short painful attacks around one eye
30mins - 3 hrs
1-2 times a day in clusters of weeks
lacrimation and flushing maybe

Question 3

migraine

Answer 3

unilateral pulsating headache
aura - visual
photophobia, phonophobia
NV

Question 4

meningitis

Answer 4

photophobia
neck stiffness
non blanching petechial rash
fever
NV
seizures

Question 5

temporal arteritis

Answer 5

unilateral throbbing headache
prominent temporal veins
jaw claudication
scalp tender
visual
>55

Question 6

SAH

Answer 6

v sudden sever headahce, like brick over head, worst at headache onset
meningism
seizures
dropped gcs
NV

Question 7

raised ICP

Answer 7

worse in moorning, coughing, bending
vomiting
reduced GCS
neuro deficits
seizures
Hx of malignancy or immunocompromise

Question 8

glaucoma

Answer 8

pain one eye, swellinng and red
visual blurring
halos

Question 9

sinusitis

Answer 9

worse leaning forward headache
rhinorrhoea

Question 10

Hx for neuro

for cauda equina?

Answer 10

SOCRATES
General: headache, fever, WL, rashes

Neuro general:
- fit, fall, LOC
- dizzy, memory loss, vision/hearing/speech

Meningism (photophob, neckstiffness)

motor:
- weakness, incontinence
sensory

Cauda equina
- weakness /radicular pain legs
- urine incont/retention, faecal incont
- saddle anaesthesia (cant feel toilet ppr)
- back pain

Question 11

Cauda equina

Exam

causes

Rx

Answer 11

Exam
- decreased perianal sensation
- decreased anal tone
- motor weakness
- sensory deficit
- diminished reflexes
(LMN)

causes:
L4/5 and L5/S1 disc herniation
neoplasms, abscesses, iatrogenic causes (manipulation, spinal anaestheesia, post op haematoma)

urgent whole spine MRI
surgical decomp within 48hrs

if malignancy on MRI or high suspicioon - dex 16mg OD + PPI

Question 12

Px of

• extradural
• subdural
• SAH

Answer 12

Extradural
- head trauma in young
- brief LOC, lucid interval, deteriorating GCS + headache
- contralateral hemiplegia

CT: biconvex

Subdural
- more gradual than extradural
- gradually increasing headache + confusion
- older pts, Hx head trauma, alcohol, anticoag

CT: biconcave, crescent shape, doesnt follow sutures

SAH
- acute severe , blow to back of head
- seizures
- neuro deficits
- decreased GCS

CT: hyperdensity in centre brain expanding bilaterally

Question 13

Extra dural on CT
worrying signs

Answer 13

CT: biconvex haematoma
contained by skull sutures

lentiform heterogenous hyperdense extra axial collection

check midline shift
subfalcine or uncal herniation